Prolonged selective neutropenia after allogeneic bone marrow transplantation: possible effect of presensitization by donor lymphocytes prior to transplant.
Selective neutropenia lasting over five months occurred in a 17-year-old adolescent male who received an allogeneic bone marrow transplantation (BMT) from an HLA-identical sibling for severe aplastic anemia. Bone marrow specimens showed maturation arrest of myeloid precursor cells despite sustained engraftment. Cytogenetic analyses revealed complete donor-type chimerism in hematopoietic cells and mixed lymphoid chimerism. The patient received a second BMT from the same donor following more intensive conditioning, including total body irradiation. Neutrophil recovery was rapid and complete donor-type hematopoietic and lymphoid chimerism was observed within three weeks of the second transplant. The present case suggests that prolonged selective neutropenia following BMT is due to residual host-derived immunity which is resistant to the standard immunosuppressive conditioning used prior to BMT for aplastic anemia.
Towatari
M
M
First Department of Internal Medicine, Nagoya University School of Medicine, Japan.
Miyamura
K
K
Akatsuka
Y
Y
Yamamoto
K
K
Minami
S
S
Kodera
Y
Y
D000293:Adolescent; D016026:Bone Marrow Transplantation / Q000009:adverse effects*; D002908:Chronic Disease; D003131:Combined Modality Therapy; D006801:Humans; D017710:Lymphocyte Transfusion; D008297:Male; D009503:Neutropenia / Q000209:etiology*; D009504:Neutrophils / Q000276:immunology*; D014019:Tissue Donors; D014184:Transplantation, Homologous